WSR 07-12-022

EMERGENCY RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed May 29, 2007, 8:29 a.m. , effective June 1, 2007 ]


Effective Date of Rule: June 1, 2007.

Purpose: The division of developmental disabilities (DDD) has had ongoing discussions with the federal Center for Medicare and Medicaid Services (CMS) and has received approval from CMS to amend its waivers under Section 1915 of the Social Security Act. These amendments also respond to the proposed order and settlement agreement under Boyle v. Arnold-Williams and incorporate the provisions of the letter of agreement between the state of Washington (office of financial management) and the Service Employees International Union (SEIU). Finally these rules are necessary to implement the recommendations in a June 2003 performance audit by the joint legislative audit and review committee. These rules have been filed under the proposed rule making CR-102 filed as WSR 07-11-130 on May 22, 2007.

Citation of Existing Rules Affected by this Order:

Washington Administrative Code Effect of Rule
388-845-0001 - Definitions
"DDD assessment" (new) Defines DDD assessment.
"Family" (new) Defines family.
"Individual support plan (ISP)" (new) Defines ISP.
"Legal representative" (new) Defines legal representative.
"Necessary supplemental accommodation representative" (new) Defines necessary supplemental accommodation representative.
"Plan of care (POC)" (amended) Specifies that the POC remains in effect until the DDD assessment is administered and the ISP is developed.
"Providers" (amended) Clarifies that providers must meet all provider qualifications and are contracted with ADSA.
"Respite assessment" (amended) Defines the respite assessment as an algorithm.
388-845-0015 (amended) Eliminates reference to CAP waiver and changes tense to reflect current situation.
388-845-0025 (deleted) Deletes section as conversion from CAP waiver is complete.
388-845-0030 (amended) Corrects cross references and adds the ISP as an alternative to the POC.
388-845-0031 (new) Clarifies that one cannot be enrolled in more than one HCBS waiver at the same time.
388-845-0035 (amended) Clarifies that enrollment in a new or different HCBS waiver is not guaranteed.
388-845-0040 (amended) Clarifies that DDD may limit capacity.
388-845-0041 (amended) Adds the ISP as an alternative to the POC.
388-845-0045 (amended) Clarifies that individuals may be enrolled from the statewide data base when there is capacity and funding for new waiver participants and revises "health and safety" to "health and welfare."
388-845-0050 (amended) Adds reference to requests for enrollment in a different waiver.
399-845-0052 (new) Defines the process for requests to be enrolled in a different waiver and DDD's notice requirement in accordance with the Boyle lawsuit.
388-845-0055 (amended) Clarifies language concerning ongoing eligibility once one is enrolled in a waiver and changes the reference from the CARE assessment to the DDD assessment.
388-845-0060 (amended) Clarifies when enrollment in a waiver can be terminated, adds a monthly monitoring plan as an alternative to receiving a waiver service as an eligibility condition, and adds the ISP as an alternative to the POC.
388-845-0070 (amended) Specifies that DDD uses the DDD assessment as specified in chapter 388-828 WAC to determine if the client needs ICF/MR level of care.
388-845-0075 through 388-845-0096 (deleted) Deletes theses sections as the information is contained in chapter 388-828 WAC.
388-845-0100 (amended) Defines the criteria for assignment to the most cost-effective DDD waiver and eliminates the criteria use for conversion from the expired CAP waiver.
388-845-0105 (amended) Adds the ISP as an alternative to the POC.
388-845-0110 (amended) Adds the ISP as an alternative to the POC.
388-845-0111 (new) Defines the limitations regarding who can provide waiver services.
388-845-0200 (amended) Revises the source of the definition of waiver services available from the service plan to the POC or ISP.
388-845-0205 (amended) Defines the yearly limits as those determined by the DDD assessment and clarifies that emergency services are available only for aggregate services and/or employment/day program services.
388-845-0210 (amended) Defines the yearly limits as those determined by the DDD assessment and clarifies that emergency services are available only for aggregate services and/or employment/day program services.
388-845-0215 (amended) Adds the ISP as an alternative to the POC and defines the yearly limits as those determined by the DDD assessment.
388-845-0220 (amended) Adds the ISP as an alternative to the POC.
388-845-0510 (amended) Clarifies that approval is required from the DDD regional administrator or designee.
388-845-0800 (amended) Clarifies that emergency services are available only for aggregate services and/or employment/day program services.
388-845-0820 (amended) Clarifies that approval is required from the DDD regional administrator or designee, adds the ISP as an alternative to the POC, and clarifies that emergency services are available only for aggregate services and/or employment/day program services.
388-845-0900 (amended) Adds the ISP as an alternative to the POC.
388-845-0910 (amended) Clarifies that approval is required from the DDD regional administrator or designee.
388-845-1300 (amended) Revises the wording and clarifies the reference for personal care services.
388-845-1310 (amended) Deletes reference to the obsolete children's comprehensive assessment and clarifies that the maximum number of hours of personal care is determined by the CARE assessment within the DDD service level assessment.
388-845-1505(5) (amended) Clarifies the types of providers for children and corrects WAC cross reference.
388-845-1515 (amended) Adds limitations to alternate living services within the CORE waiver and requires the initial authorization of residential habilitation services to have prior approval by the DDD regional administrator or designee.
388-845-1605 (amended) Clarifies that the client is the one eligible for respite care and limits respite to parents who provided care prior to June 2007.
388-845-1606 (deleted) Deletes reference to exceptions to the requirements before July 2006.
388-845-1610 (amended) Eliminates state operated living alternative (SOLA) and other certified supported living situations as settings where respite may be provided, and allows the respite provider to take the client into the community.
388-845-1615 (amended) Corrects cross-references.
388-845-1620 (amended) Clarifies that the DDD assessment determines how much respite may be received for the Basic, Basic Plus and CORE waivers, clarifies that prior approval is required from the DDD regional administrator or designee, requires prior approval to pay for more than eight hours in a twenty-four hour period in any setting other than the client's home or place of residence, allows the respite provider to take the client into the community, and specifies that DDD cannot pay for fees associated with the respite care.
388-845-1660 (amended) Specifies that prior approval is required from the DDD regional administrator or designee.
388-845-1710 (amended) Specifies that prior approval is required from the DDD regional administrator or designee for all skilled nursing services, and changes the agency responsible for determining the need for service and the right to require a second opinion from the department to DDD.
388-845-1800 (amended) Defines specialized medical equipment and supplies, clarifies that these services cannot be available through Medicaid or the state plan, adds a cross reference to WAC 388-543-1000, and clarifies that these services are available in all four DDD HCBS waivers.
388-845-1810 (amended) Specifies that prior approval is required from the DDD regional administrator or designee, and changes the agency responsible for determining the need for the right to require a second opinion from the department to DDD.
388-845-1910 (amended) Specifies that prior approval is required from the DDD regional administrator or designee for all specialized psychiatric services.
388-845-2000 (amended) Adds the ISP as an alternative to the POC.
388-845-2005 (amended) Adds recreational therapists as a qualified provider of staff/family consultation and training.
388-845-2010 (amended) Specifies that prior approval is required from the DDD regional administrator or designee.
388-845-2200 (amended) Adds the ISP as an alternative to the POC, and clarifies that transportation services are available only if the cost and responsibility for transportation is not already included in the provider's contract and payment.
388-845-2210 (amended) Specifies that prior approval is required from the DDD regional administrator or designee.
388-845-3000 (amended) Specifies that service needs are determined through the DDD assessment, only identified health and welfare needs will be authorized for payment, the amount of respite care for the Basic, Basic Plus and CORE waivers is determined by the DDD assessment, and adds the ISP as an alternative to the POC.
388-845-3005 through 388-845-3050 (deleted) Deletes these sections as they are contained in the DDD assessment and service planning process as defined in chapter 388-828 WAC.
388-845-3055 (amended) Specifies that the ISP replaces the POC; clarifies that the POC remains in effect until the ISP is developed; specifies that the ISP must include identified health and welfare needs, and both paid and unpaid services approved to meet these identified health and welfare needs; and specifies that a signature or verbal consent by the client or legal representative is required on an initial, reassessment or review of the ISP.
388-845-3056 (new) Specifies what actions DDD will take if an individual needs additional help in understanding the ISP.
388-845-3060 (amended) Adds the ISP as an alternative to the POC, and specifies that a signature or verbal consent is required on an initial, reassessment or review of the ISP.
388-845-3061 (new) Specifies that a change in the plan of care or ISP can be made immediately upon a verbal request prior to receiving a signature.
388-845-3062 (new) Specifies who must sign or give verbal consent to the ISP and adds a reference to WAC 388-845-3056 if an individual needs assistance to understand the ISP.
388-845-3065 (amended) Specifies that the plan of care remains in effect until it is replaced by the ISP and that the ISP is effective through the last day of the twelfth month following the effective date or until a new ISP is completed.
388-845-3070 (amended) Changes plan of care to ISP; specifies that on an initial plan, DDD will be unable to provide waiver services if a signature or verbal consent is not obtained, will not assume consent, and will follow the steps described in WAC 388-845-3056; specifies that for a reassessment or review, if a client is able to understand the ISP, and if a signature or verbal consent is not obtained, DDD will continue existing services through the end of the advance notice period and at the end of the advance notice period, DDD will assume consent and implement the new ISP without a signature or verbal consent; specifies that for a reassessment or review, if a client is not able to understand the ISP, and if a signature or verbal consent is not obtained, DDD will continue existing services in accordance with WAC 388-845-3056; and includes an additional cross-reference for appeal rights.
388-845-3075 (amended) Adds the ISP as an alternative to the POC.
388-845-3095 (amended) Clarifies the client's responsibility in paying toward the cost of waiver services.
388-845-4000 (amended) Clarifies additional appeal rights under the waiver.
388-845-4005 (amended) Clarifies appeal rights to include the provisions contained in the Boyle lawsuit.

Statutory Authority for Adoption: RCW 71A.12.30 [71A.12.030].

Other Authority: Title 71A RCW.

Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.

Reasons for this Finding: These amendments are necessary to comply with the proposed order and settlement listed above and to allow the state of Washington to continue to claim federal matching funds under Title XIX of the Social Security Act. These rules are also necessary to implement the recommendations in a June 2003 performance audit by the joint legislative audit and review committee and to support chapter 388-828 WAC, which will become permanent on June 1, 2007.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 6, Amended 51, Repealed 16.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 6, Amended 51, Repealed 16.

Date Adopted: May 15, 2007.

Stephanie E. Schiller

Rules Coordinator

3846.4
AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0001   Definitions.   "ADSA" means the aging and disability services administration, an administration within the department of social and health services.

"Aggregate Services" means a combination of services subject to the dollar limitations in the Basic and Basic Plus waivers.

"CAP waiver" means the community alternatives program waiver.

"CARE" means the comprehensive assessment and reporting evaluation.

"DDD" means the division of developmental disabilities, a division within the aging and disability services administration of the department of social and health services.

"DDD Assessment" refers to the standardized assessment tool as defined in chapter 388-828 WAC, used by DDD to measure the support needs of persons with developmental disabilities.

"Department" means the department of social and health services.

"Employment/day program services" means community access, person-to-person, prevocational services or supported employment services subject to the dollar limitations in the Basic and Basic Plus waivers.

"Family" means relatives who live in the same home with the eligible client. Relatives include natural, adoptive or step parents; grandparents; brother; sister; stepbrother; stepsister; uncle; aunt; first cousin; niece; or nephew.

"HCBS waivers" means home and community based services waivers.

"ICF/MR" means an intermediate care facility for the mentally retarded.

"Individual Support Plan (ISP)" is a document that authorizes and identifies the DDD paid services to meet a client's assessed needs.

"Legal Representative" means a parent of a person who is under eighteen years of age, a person's legal guardian, a person's limited guardian when the subject matter is within the scope of limited guardianship, a person's attorney at law, a person's attorney in fact, or any other person who is authorized by law to act for another person.

"Necessary Supplemental Accommodation Representative" means an individual who receives copies of DDD planned action notices (PANs) and other department correspondence in order to help a client understand the documents and exercise the client's rights. A necessary supplemental accommodation representative is identified by a client of DDD when the client does not have a legal guardian and the client is requesting or receiving DDD services.

"Plan of care (POC)" means the primary tool DDD uses to determine and document your needs and to identify services to meet those needs until the DDD assessment is administered and the individual support plan is developed.

"Providers" means an individual or agency who ((is licensed, certified and/or)) meets the provider qualifications and is contracted with ADSA to provide services to you.

"Respite assessment" means ((a series of questions about you and your caregiver used to determine the amount of respite care available to you)) an algorithm within the DDD assessment that determines the number of hours of respite care you may receive per year if you are enrolled in the Basic, Basic Plus, or Core waiver.

"SSI" means Supplemental Security Income, an assistance program administered by the federal Social Security Administration for blind, disabled and aged individuals.

"SSP" means state supplementary payment, a benefit administered by the department intended to augment an individual's SSI.

"State funded services" means services that are funded entirely with state dollars.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0001, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0015   What HCBS waivers are provided by the division of developmental disabilities (DDD)?   DDD ((has replaced its community alternatives program (CAP) waiver with)) provides services through four HCBS waivers:

(1) Basic waiver;

(2) Basic Plus waiver;

(3) CORE waiver; and

(4) Community protection waiver.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0015, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0030   Do I meet criteria for HCBS waiver-funded services?   You meet criteria for DDD HCBS waiver-funded services if you meet all of the following:

(1) You have been determined eligible for DDD services per RCW 71A.10.020(3).

(2) You have been determined to meet ICF/MR level of care per WAC 388-845-0070 ((through 388-845-0090)), 388-828-3060 and 388-828-3080.

(3) You meet disability criteria established in the Social Security Act.

(4) You meet financial eligibility requirements as defined in WAC 388-515-1510.

(5) You choose to receive services in the community rather than in an ICF/MR facility.

(6) You have a need for waiver services as identified in your plan of care or individual support plan.

(7) You are not residing in hospital, jail, prison, nursing facility, ICF/MR, or other institution.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0030, filed 12/13/05, effective 1/13/06.]


NEW SECTION
WAC 388-845-0031   Can I be enrolled in more than one HCBS waiver?   You cannot be enrolled in more than one HCBS waiver at the same time.

[]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0035   Am I guaranteed placement on a waiver if I meet waiver criteria?   (1) If you are not currently enrolled in a waiver, meeting criteria for the waiver does not guarantee access to or receipt of waiver services.

(2) If you are currently on a waiver and you have been determined to have health and welfare needs that can be met only by services available on a different waiver, you are not guaranteed enrollment in that different waiver.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0035, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0040   Is there a limit to the number of people who can be enrolled in each HCBS waiver?   Each waiver has a capacity limit on the number of people who can be served in a waiver year. In addition, DDD has the authority to limit ((enrollment into the waivers)) capacity based on availability of funding for new waiver participants.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0040, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0041   What is DDD's responsibility to provide my services under the waivers administered by DDD?   If you are enrolled in an HCBS waiver administered by DDD, DDD must meet your assessed needs for health and welfare.

(1) DDD must address your assessed health and welfare needs in your plan of care or the individual support plan, as specified in WAC 388-845-3055.

(2) You have access to DDD paid services that are provided within the scope of your waiver, subject to the limitations in WAC 388-845-0110 and WAC 388-845-0115.

(3) DDD will provide waiver services you need and qualify for within your waiver.

(4) DDD will not deny or limit your waiver services based on a lack of funding.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0041, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0045   When there is capacity to add people to a waiver, how does DDD determine who will be enrolled?   When there is capacity on a waiver and available funding for new waiver participants, DDD may enroll people from the statewide database in a waiver based on the following priority considerations:

(1) First priority will be given to current waiver participants assessed to require a different waiver because their needs have increased and these needs cannot be met within the scope of their current waiver.

(2) DDD may also consider any of the following populations in any order:

(a) Priority populations as identified and funded by the legislature.

(b) Persons DDD has determined to be in immediate risk of ICF/MR admission due to unmet health and ((safety)) welfare needs.

(c) Persons identified as a risk to the safety of the community.

(d) Persons currently receiving services through state-only funds.

(e) Persons on an HCBS waiver that provides services in excess of what is needed to meet their identified health and welfare needs.

(f) Persons who were previously on an HCBS waiver since April 2004 and lost waiver eligibility per WAC 388-845-0060(9).

(3) For the Basic waiver only, DDD may consider persons who need the waiver services available in the Basic waiver to maintain them in their family's home.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0045, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0050   How do I request to be enrolled in a waiver?   (1) You can contact DDD and request to be enrolled in a waiver or to enroll in a different waiver at any time.

(((1))) (2) If you are assessed as meeting ICF/MR level of care as defined in WAC 388-845-0070 and chapter 388-828 WAC, your request for waiver enrollment will be documented by DDD in a statewide data base.

(((2) When there is capacity available to enroll additional people in a waiver, WAC 388-845-0045 describes how DDD will determine who will be enrolled.))

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0050, filed 12/13/05, effective 1/13/06.]


NEW SECTION
WAC 388-845-0052   What is the process if I am already on a waiver and request enrollment onto a different waiver?   (1) If you are already enrolled in a DDD HCBS waiver and you request to be enrolled in a different waiver DDD will do the following:

(a) Assess your needs to determine whether your health and welfare needs can be met with services available on your current waiver or whether those needs can only be met through services offered on a different waiver.

(b) If DDD determines your health and welfare needs can be met by services available on your current waiver your enrollment request will be denied.

(c) If DDD determines your health and welfare needs can only be met by services available on a different waiver your service need will be reflected in your ISP.

(d) If DDD determines there is capacity on the waiver that is determined to meet your needs, DDD will place you on that waiver.

(2) You will be notified in writing of DDD's decision under subsection (1)(a) of this section and if your health and welfare needs cannot be met on your current waiver, DDD will notify you in writing whether there is capacity on the waiver that will meet your health and welfare needs and whether you will be enrolled on that waiver. If current capacity on that waiver does not exist, your eligibility for enrollment onto that different waiver will be tracked on a statewide database.

[]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0055   How do I remain eligible for the waiver?   ((If you are already on a HCBS waiver,)) Once you are enrolled in a DDD HCBS waiver, you can remain eligible if you ((must)) continue to meet eligibility criteria in WAC 388-845-0030.

(1) DDD completes a reassessment at least every twelve months to determine if you continue to meet all of these eligibility requirements ((in WAC 388-845-0030.)); and

(2) You must either receive a waiver service at least once in every thirty consecutive days, as specified in WAC 388-513-1320 (3)(b)((.)) or your health and welfare needs require a monthly monitoring plan; and

(3) Your ((plan of care, CARE)) DDD assessment/reassessment ((and respite assessment/reassessment)) must be done in person and in your home. See WAC 388-828-1180.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0055, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0060   Can my waiver ((eligibility)) enrollment be terminated?   DDD may terminate your waiver ((eligibility)) enrollment if DDD determines that:

(1) Your health and ((safety)) welfare needs cannot be met in your current waiver or for one of the following reasons:

(((1))) (a) You no longer meet one or more of the requirements listed in WAC 388-845-0030;

(((2))) (b) You ((no longer)) do not have an identified need for a waiver service((s)) at the time of your annual plan of care or individual support plan;

(((3))) (c) You do not use a waiver service at least once in every thirty consecutive days and your health and welfare do not require monthly monitoring;

(((4))) (d) You are on the community protection waiver and choose not to be served by a certified residential community protection provider-intensive supported living services (CP-ISLS);

(((5))) (e) You choose to disenroll from the waiver;

(((6))) (f) You reside out of state;

(((7))) (g) You cannot be located or do not make yourself available for the annual waiver reassessment of eligibility;

(((8))) (h) You refuse to participate with DDD in:

(((a))) (i) Service planning;

(((b))) (ii) Required quality assurance and program monitoring activities; or

(((c))) (iii) Accepting services agreed to in your plan of care or individual support plan as necessary to meet your health and ((safety)) welfare needs.

(((9))) (i) You are residing in a hospital, jail, prison, nursing facility, ICF/MR, or other institution and remain in residence at least one full calendar month, and are still in residence:

(((a))) (i) At the end of the twelfth month following the effective date of your current plan of care or individual support plan, as described in WAC 388-845-3060; or

(((b))) (ii) On March 31st, the end of the waiver fiscal year, whichever date occurs first.

(((10))) (j) Your needs exceed the maximum funding level or scope of services under the Basic or Basic Plus waiver as specified in WAC 388-845-3080; or

(((11))) (k) Your needs exceed what can be provided under the CORE or community protection waiver as specified in WAC 388-845-3085; or

(2) Services offered on a different waiver can meet your health and welfare needs and DDD enrolls you on a different waiver.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0060, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0070   What determines if I need ICF/MR level of care?   DDD determines if you need ICF/MR level of care based on your need for waiver services. To reach this decision, DDD uses ((its department-approved)) the DDD assessment ((and/or other information)) as specified in ((WAC 388-845-0085)) chapter 388-828 WAC.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0070, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0100   What determines which waiver I am assigned to?   ((DDD will assign you to a waiver based on the following criteria:

(1) If you were on the CAP waiver as of March 2004, your initial assignment to the Basic, Basic Plus, CORE, or community protection waiver was based on:

(a) Services you received from DDD in October 2002 through September 2003; and

(b) Services you were authorized to receive in October, November and December 2003.

(2) If you are new to a waiver since April 1, 2004, assignment is based on your assessment and service plan.

(3) Additional criteria apply to the assignment to the community protection waiver)) If there is capacity, DDD will assign you to the most cost effective waiver based on its evaluation of the DDD assessment and your health and welfare needs as described in chapter 388-828 WAC and the following criteria:

(1) For the Basic waiver:

(a) You must live with your family or in your own home;

(b) Your family/caregiver's ability to continue caring for you can be maintained with the addition of services provided in the Basic waiver; and

(c) You do not need out-of-home residential services.

(2) For the Basic Plus waiver, your health and welfare needs exceed the amount allowed in the Basic waiver or require a service that is not contained in the Basic waiver; and

(a) You are at high risk of out-of-home placement or loss of your current living situation; or

(b) You require out-of-home placement and your health and welfare needs can be met in an adult family home or adult residential care facility.

(3) For the Core waiver:

(a) You are at immediate risk of out-of-home placement; and/or

(b) You have an identified health and welfare need for residential services that cannot be met by the Basic Plus waiver.

(4) For the Community Protection waiver, refer to WAC 388-845-0105.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0100, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0105   What criteria determine assignment to the community protection waiver?   DDD may assign you to the community protection waiver only if you are at least eighteen years of age, not currently residing in a hospital, jail or other institution, and meet the following criteria:

(1) You have been identified by DDD as a person who meets one or more of the following:

(a) You have been convicted of or charged with a crime of sexual violence as defined in chapter 71.09 RCW;

(b) You have been convicted of or charged with acts directed towards strangers or individuals with whom a relationship has been established or promoted for the primary purpose of victimization, or persons of casual acquaintance with whom no substantial personal relationship exists;

(c) You have been convicted of or charged with a sexually violent offense and/or predatory act, and may constitute a future danger as determined by a qualified professional;

(d) You have not been convicted and/or charged, but you have a history of stalking, sexually violent, predatory and/or opportunistic behavior which demonstrates a likelihood to commit a sexually violent and/or predatory act based on current behaviors that may escalate to violence, as determined by a qualified professional; or

(e) You have committed one or more violent crimes.

(2) You receive or agree to receive residential services from certified residential community protection provider-intensive supported living services (CP-ISLS); and

(3) You comply with the specialized supports and restrictions in your:

(a) Plan of care (((POC))) or individual support plan;

(b) Individual instruction and support plan (IISP); and/or

(c) Treatment plan provided by DDD approved certified individuals and agencies.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0105, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0110   Are there limitations to the waiver services I can receive?   There are limitations to waiver services. In addition to the limitations to your access to nonwaiver services cited for specific services in WAC 388-845-0115, the following limitations apply:

(1) A service must be offered in your waiver and authorized in your plan of care or individual support plan.

(2) Mental health stabilization services may be added to your plan of care or individual support plan after the services are provided.

(3) Waiver services are limited to services required to prevent ICF/MR placement.

(4) The cost of your waiver services cannot exceed the average daily cost of care in an ICF/MR.

(5) Waiver services cannot replace or duplicate other available paid or unpaid supports or services.

(6) Waiver funding cannot be authorized for treatments determined by DSHS to be experimental.

(7) The Basic and Basic Plus waivers have yearly limits on some services and combinations of services. The combination of services is referred to as aggregate services or employment/day program services.

(8) Your choice of qualified providers and services is limited to the most cost effective option that meets your assessed needs.

(9) Services provided out-of-state, other than in recognized bordering cities, are limited to respite care and personal care during vacations.

(a) You may receive services in a recognized out-of-state bordering city on the same basis as in-state services.

(b) The only recognized bordering cities are:

(i) Coeur d'Alene, Moscow, Sandpoint, Priest River and Lewiston, Idaho; and

(ii) Portland, The Dalles, Hermiston, Hood River, Rainier, Milton-Freewater and Astoria, Oregon.

(10) Other out-of-state waiver services require an approved exception to rule before DDD can authorize payment.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0110, filed 12/13/05, effective 1/13/06.]


NEW SECTION
WAC 388-845-0111   Are there limitations regarding who can provide services?   The following limitations apply to providers for waiver services:

(1) Your spouse cannot be your paid provider for any waiver service.

(2) If you are under age eighteen, your natural, step, or adoptive parent cannot be your paid provider for any waiver service.

(3) If you are age eighteen or older, your natural, step, or adoptive parent cannot be your paid provider for any waiver service with the exception of:

(a) Personal care;

(b) Transportation to and from a waiver service;

(c) Residential habilitation services per WAC 388-845-1510 if your parent is certified as a residential agency per chapter 388-101 WAC; or

(d) Respite care if you and the parent who provides the respite care live in separate households.

[]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0200   What waiver services are available to me?   Each of the four HCBS waivers has a different scope of service and your ((service)) plan of care or individual support plan defines the waiver services available to you.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0200, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 07-05-014, filed 2/9/07, effective 3/12/07)

WAC 388-845-0205   Basic waiver services.  


BASIC WAIVER SERVICES YEARLY LIMIT
AGGREGATE SERVICES: May not exceed $1454 per year on any combination of these services

Behavior management and consultation
Community guide
Environmental accessibility adaptations
Occupational therapy
Physical therapy
Specialized medical equipment/supplies
Specialized psychiatric services
Speech, hearing and language services
Staff/family consultation and training
Transportation
EMPLOYMENT/DAY PROGRAM SERVICES:


Community access

May not exceed $6631 per year
Person-to-person
Prevocational services
Supported employment
Sexual deviancy evaluation Limits are determined by DDD
Respite care Limits are determined by ((respite)) the DDD assessment
Personal care Limits are determined by ((CARE)) the CARE tool used as part of the DDD assessment
MENTAL HEALTH STABILIZATION SERVICES: Limits are determined by a mental health professional or DDD

Behavior management and consultation
Mental health crisis diversion bed services
Skilled nursing
Specialized psychiatric services
Emergency assistance is only for aggregate services and/or employment/day program services contained in the Basic waiver $6000 per year; Preauthorization required

[Statutory Authority: RCW 71A.12.030, 71A.12.120. 07-05-014, 388-845-0205, filed 2/9/07, effective 3/12/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0205, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 07-05-014, filed 2/9/07, effective 3/12/07)

WAC 388-845-0210   Basic Plus waiver services.  


BASIC PLUS WAIVER SERVICES YEARLY LIMIT
AGGREGATE SERVICES: May not exceed $6192 per year on any combination of these services

Behavior management and consultation
Community guide
Environmental accessibility adaptations
Occupational therapy
Physical therapy
Skilled nursing
Specialized medical equipment/supplies
Specialized psychiatric services
Speech, hearing and language services
Staff/family consultation and training
Transportation
EMPLOYMENT/DAY PROGRAM SERVICES: May not exceed $9691 per year
Community access
Person-to-person
Prevocational services
Supported employment
Adult foster care (adult family home) Determined per department rate structure
Adult residential care (boarding home)
MENTAL HEALTH STABILIZATION SERVICES: Limits determined by a mental health professional or DDD
Behavior management and consultation
Mental health crisis diversion bed services
Skilled nursing
Specialized psychiatric services
Personal care Limits determined by the CARE tool used as part of the DDD assessment
Respite care Limits are determined by ((respite)) the DDD assessment
Sexual deviancy evaluation Limits are determined by DDD
Emergency assistance is only for aggregate services and/or employment/day program services contained in the Basic Plus waiver $6000 per year; Preauthorization required

[Statutory Authority: RCW 71A.12.030, 71A.12.120. 07-05-014, 388-845-0210, filed 2/9/07, effective 3/12/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0210, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0215   CORE waiver services.  


CORE WAIVER SERVICES YEARLY LIMIT
Behavior management and consultation Determined by the Plan of Care or individual support plan, not to exceed the average cost of an ICF/MR for any combination of services
Community guide
Community transition
Environmental accessibility adaptations
Occupational therapy
Respite care
Sexual deviancy evaluation
Skilled nursing
Specialized medical equipment/supplies
Specialized psychiatric services
Speech, hearing and language services
Staff/family consultation and training
Transportation
Residential habilitation
Community access
Person-to-person
Prevocational services
Supported employment
MENTAL HEALTH STABILIZATION SERVICES: Limits determined by a mental health professional or DDD

Behavior management and consultation
Mental health crisis diversion bed services
Skilled nursing
Specialized psychiatric services
Personal care ((Limited)) Limits determined by the CARE tool used as part of the DDD assessment

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0215, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0220   Community protection waiver services.  


COMMUNITY PROTECTION WAIVER SERVICES YEARLY LIMIT
Behavior management and consultation Determined by the Plan of Care or individual support plan, not to exceed the average cost of an ICF/MR for any combination of services
Community transition
Environmental accessibility adaptations
Occupational therapy
Physical therapy
Sexual deviancy evaluation
Skilled nursing
Specialized medical equipment and supplies
Specialized psychiatric services
Speech, hearing and language services
Staff/family consultation and training
Transportation
Residential habilitation
Person-to-person
Prevocational services
Supported employment
MENTAL HEALTH STABILIZATION SERVICES: Limits determined by a mental health professional or DDD

Behavioral management and consultation
Mental health crisis diversion bed services
Skilled nursing
Specialized psychiatric services

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0220, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0510   Are there limits to the behavior management and consultation I can receive?   The following limits apply to your receipt of behavior management and consultation:

(1) DDD and the treating professional will determine the need and amount of service you will receive, subject to the limitations in subsection (2) below.

(2) The dollar limitations for aggregate services in your Basic and Basic Plus waiver limit the amount of service unless provided as a mental health stabilization service.

(3) DDD reserves the right to require a second opinion from a department-selected provider.

(4) Behavior management and consultation not provided as a mental health stabilization service requires prior approval by the DDD regional administrator or designee.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0510, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0800   What is emergency assistance?   Emergency assistance is a temporary increase to the yearly aggregate services and/or employment/day program services dollar limit specified in the Basic and Basic Plus waiver when additional waiver services are required to prevent ICF/MR placement. These additional services are limited to the services provided in your waiver.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0800, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0820   Are there limits to my use of emergency assistance?   All of the following limitations apply to your use of emergency assistance:

(1) Prior ((authorization)) approval by the DDD regional administrator or designee is required based on a reassessment of your plan of care or individual support plan to determine the need for emergency services;

(2) Payment authorizations are reviewed every thirty days and cannot exceed six thousand dollars per twelve months based on the effective date of your current plan of care (((POC))) or individual support plan;

(3) Emergency assistance services are limited to the ((scope of services in your)) aggregate services and employment/day program services in the Basic and Basic Plus waivers;

(4) Emergency assistance may be used for interim services until:

(a) The emergency situation has been resolved; or

(b) You are transferred to alternative supports that meet your assessed needs; or

(c) You are transferred to an alternate waiver that provides the service you need.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0820, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0900   What are environmental accessibility adaptations?   (1) Environmental accessibility adaptations are available in all of the HCBS waivers and provide the physical adaptations to the home required by the individual's plan of care or individual support plan needed to:

(a) Ensure the health, welfare and safety of the individual; or

(b) Enable the individual who would otherwise require institutionalization to function with greater independence in the home.

(2) Environmental accessibility adaptations may include the installation of ramps and grab bars, widening of doorways, modification of bathroom facilities, or installing specialized electrical and/or plumbing systems necessary to accommodate the medical equipment and supplies that are necessary for the welfare of the individual.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0900, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-0910   What limitations apply to environmental accessibility adaptations?   The following service limitations apply to environmental accessibility adaptations:

(1) ((Prior approval by DDD is required)) Environmental accessibility adaptations require prior approval by the DDD regional administrator or designee.

(2) Environmental accessibility adaptations or improvements to the home are excluded if they are of general utility without direct medical or remedial benefit to the individual, such as carpeting, roof repair, central air conditioning, etc.

(3) Environmental accessibility adaptations cannot add to the total square footage of the home.

(4) The dollar limitations for aggregate services in your Basic or Basic Plus waiver limit the amount of service you may receive.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-0910, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1300   What are personal care services?   Personal care services as defined in WAC 388-106-0010 are the provision of assistance with personal care tasks ((as defined in WAC 388-106-0010, personal care services)). These services are available in the Basic, Basic Plus, and CORE waivers.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-1300, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1310   Are there limits to the personal care services I can receive?   (1) You must meet the programmatic eligibility for Medicaid personal care in chapters 388-106 and 388-71 WAC governing Medicaid personal care (MPC) using the current department approved assessment form: Comprehensive assessment reporting evaluation (CARE) ((or children's comprehensive assessment)).

(2) The maximum hours of personal care you may receive are determined by the ((approved department assessment for Medicaid personal care services)) CARE tool used as part of the DDD assessment.

(a) Provider rates are limited to the department established hourly rates for in-home Medicaid personal care.

(b) Homecare agencies must be licensed through the department of health and contracted with DDD.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-1310, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1505   Who are qualified providers of residential habilitation services for the CORE waiver?   Providers of residential habilitation services for participants in the CORE waiver must be one of the following:

(1) Individuals contracted with DDD to provide residential support as a "companion home" provider;

(2) Individuals contracted with DDD to provide training as an "alternative living provider";

(3) Agencies contracted with DDD and certified per chapter 388-101 WAC;

(4) State-operated living alternatives (SOLA);

(5) Licensed and contracted group care homes, ((group training homes,)) foster homes, child placing agencies((,)) or staffed residential homes ((or adult residential rehabilitation centers per WAC 246-325-0012)) per chapter 388-148 WAC.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-1505, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1515   Are there limits to the residential habilitation services I can receive?   (1) You may only receive one type of residential habilitation service at a time.

(2) None of the following can be paid for under the CORE or community protection waiver:

(a) Room and board;

(b) The cost of building maintenance, upkeep, improvement, modifications or adaptations required to assure the health and safety of residents, or to meet the requirements of the applicable life safety code;

(c) Activities or supervision already being paid for by another source;

(d) Services provided in your parent's home unless you are receiving alternative living services for a maximum of six months to transition you from your parent's home into your own home.

(3) Alternative living services in the CORE waiver cannot:

(a) Exceed forty hours per month;

(b) Provide personal care or protective supervision.

(4) The following persons cannot be paid providers for your service:

(a) Your spouse;

(b) Your natural, step, or adoptive parents if you are a child age seventeen or younger;

(c) Your natural, step, or adoptive parent unless your parent is certified as a residential agency per chapter 388-101 WAC or is employed by a certified or licensed agency qualified to provide residential habilitation services.

(5) The initial authorization of residential habilitation services requires prior approval by the DDD regional administrator or designee.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-1515, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1605   Who is eligible to receive respite care?   ((The person providing your care is eligible to receive respite care)) You are eligible to receive respite care if you are in the Basic, Basic Plus or CORE waiver and:

(1) You live in a private home ((with an unpaid caregiver)) and no one living with you is paid to be your caregiver; or

(2) You live with a ((paid)) caregiver who is your natural, step or adopted parent who:

(a) ((A natural, step or adoptive parent)) Was paid by DDD to provide care to you as an individual provider prior to June 2007; and

(b) You were receiving respite prior to June 2007; or

(3) You live with a caregiver who is paid by DDD to provide care to you and is:

(a) A contracted companion home provider; or

(((c))) (b) A licensed children's foster home provider.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-1605, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1610   Where can respite care be provided?   (1) Respite care can be provided in the following location(s):

(((1))) (a) Individual's home or place of residence;

(((2))) (b) Relative's home;

(((3))) (c) Licensed children's foster home;

(((4))) (d) Licensed, contracted and DDD certified group home;

(((5) State operated living alternative (SOLA) and other DDD certified supported living settings;

(6))) (e) Licensed boarding home contracted as an adult residential center;

(((7))) (f) Adult residential rehabilitation center;

(((8))) (g) Licensed and contracted adult family home;

(((9))) (h) Children's licensed group home, licensed staffed residential home, or licensed childcare center;

(((10))) (i) Other community settings such as camp, senior center, or adult day care center.

(2) None of these settings prohibit the respite care provider from taking you into the community.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-1610, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1615   Who are qualified providers of respite care?   Providers of respite care can be any of the following individuals or agencies contracted with DDD for respite care:

(1) Individuals meeting the provider qualifications under chapter 388-825 WAC;

(2) Homecare/home health agencies, licensed under chapter 246-335 WAC, Part 1;

(3) Licensed and contracted group homes, foster homes, child placing agencies, staffed residential homes and foster group care homes;

(4) Licensed and contracted adult family home;

(5) Licensed and contracted adult residential care facility;

(6) Licensed and contracted adult residential ((rehabilitation center)) treatment facility under ((WAC 246-325-012)) chapter 246-337 WAC;

(7) Licensed childcare center under chapter ((388-295)) 175-295 WAC;

(8) Licensed child daycare center under chapter ((388-295)) 175-295 WAC;

(9) Adult daycare centers contracted with DDD;

(10) Certified provider ((per)) under chapter 388-101 WAC when respite is provided within the DDD contract for certified residential services; or

(11) Other DDD contracted providers such as community center, senior center, parks and recreation, summer programs, adult day care.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-1615, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1620   Are there limits to the respite care I can receive?   The following limitations apply to the respite care you can receive:

(1) ((If you are in the Basic or Basic Plus waiver, a respite care)) The DDD assessment will determine how much respite you can receive per ((WAC 388-845-3005 through 388-845-3050)) chapter 388-828 WAC.

(2) ((If you are in the CORE waiver, the plan of care (POC), not the respite assessment, will determine the amount of respite care you can receive.

(3))) Prior approval by the DDD regional administrator or designee is required:

(a) To exceed fourteen days of respite care per month; or

(b) To pay for more than eight hours in a twenty-four hour period of time for respite care in any setting other than your home or place of residence. This limitation does not prohibit your respite care provider from taking you into the community, per WAC 388-845-1610(2).

(((4))) (3) Respite cannot replace:

(a) Daycare while a parent or guardian is at work; and/or

(b) Personal care hours available to you. When determining your unmet need, DDD will first consider the personal care hours available to you.

(((5))) (4) Respite providers have the following limitations and requirements:

(a) If respite is provided in a private home, the home must be licensed unless it is the client's home or the home of a relative of specified degree per WAC 388-825-345;

(b) The respite provider cannot be the spouse of the caregiver receiving respite if the spouse and the caregiver reside in the same residence; and

(c) If you receive respite from a provider who requires licensure, the respite services are limited to those age-specific services contained in the provider's license.

(((6))) (5) Your caregiver cannot provide paid respite services for you or other persons during your respite care hours.

(((7))) (6) DDD cannot pay for any fees associated with the respite care; for example, membership fees at a recreational facility, or insurance fees.

(7) If you require respite from a licensed practical nurse (LPN) or a registered nurse (RN), services may be authorized as skilled nursing services per WAC 388-845-1700 using an LPN or RN. If you are in the Basic Plus waiver, skilled nursing services are limited to the dollar limits of your aggregate services per WAC 388-845-0210. ((The dollar limit governing aggregate services does not apply to skilled nursing services provided as part of mental health stabilization services per WAC 388-845-1100(2).))

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-1620, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1660   Are there limitations to the sexual deviation evaluations I can receive?   (1) The evaluations must meet the standards contained in WAC 246-930-320.

(2) Sexual deviation evaluations require prior approval by the DDD regional administrator or designee.

(3) The costs of sexual deviation evaluations do not count toward the dollar limits for aggregate services in the Basic or Basic Plus waivers.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-1660, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1710   Are there limitations to the skilled nursing services I can receive?   The following limitations apply to your receipt of skilled nursing services:

(1) Skilled nursing services require prior approval by the DDD regional administrator or designee.

(2) ((The department)) DDD and the treating professional determine the need for and amount of service.

(3) ((The department)) DDD reserves the right to require a second opinion by a department-selected provider.

(4) ((Skilled nursing services provided as a mental health stabilization service require prior approval by DDD or its designee.

(5))) The dollar limitation for aggregate services in your Basic Plus waiver limit the amount of skilled nursing services unless provided as a mental health stabilization service.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-1710, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1800   What are specialized medical equipment and supplies?   (1) Specialized medical equipment and supplies are ((services to help)) durable and nondurable medical equipment not available through medicaid or the state plan which enables individuals to:

(a) Increase their abilities to perform ((with)) their activities of daily living; or ((to better participate in their environment. These services are available in all four HCBS waivers))

(b) Perceive, control or communicate with the environment in which they live.

(2) Durable and nondurable medical equipment are defined in WAC 388-543-1000 and 388-543-2800 respectively.

(3) Also included are ((devices, controls, appliances, and)) items necessary for life support; and ancillary supplies and equipment necessary to the proper functioning of ((such items; and durable and nondurable medical equipment not available through Medicaid under the Medicaid state plan)) the equipment and supplies described in subsection (1) above.

(4) Specialized medical equipment and supplies are available in all four HCBS waivers.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-1800, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1810   Are there limitations to my receipt of specialized medical equipment and supplies?   The following limitations apply to your receipt of specialized medical equipment and supplies:

(1) ((Prior approval by the department is required)) Specialized medical equipment and supplies require prior approval by the DDD regional administrator or designee for each authorization.

(2) ((The department)) DDD reserves the right to require a second opinion by a department-selected provider.

(3) Items reimbursed with waiver funds shall be in addition to any medical equipment and supplies furnished under the Medicaid state plan.

(4) Items must be of direct medical or remedial benefit to the individual and necessary as a result of the individual's disability.

(5) Medications, prescribed or nonprescribed, and vitamins are excluded.

(6) The dollar limitations for aggregate services in your Basic or Basic Plus waiver limit the amount of service you may receive.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-1810, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-1910   Are there limitations to the specialized psychiatric services I can receive?   (1) Specialized psychiatric services are excluded if they are available through other Medicaid programs.

(2) The dollar limitations for aggregate service in your Basic and Basic Plus waiver limit the amount of specialized psychiatric services unless provided as a mental health stabilization service.

(3) Specialized psychiatric services ((provided as a mental health stabilization service require prior approval by DDD or its designee)) require prior approval by the DDD regional administrator or designee.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-1910, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-2000   What is staff/family consultation and training?   (1) Staff/family consultation and training is professional assistance to families or direct service providers to help them better meet the needs of the waiver person. This

service is available in all four HCBS waivers.

(2) Consultation and training is provided to families, direct staff, or personal care providers to meet the specific needs of the waiver participant as outlined in the individual's plan of care or individual support plan, including:

(a) Health and medication monitoring;

(b) Positioning and transfer;

(c) Basic and advanced instructional techniques;

(d) Positive behavior support; and

(e) Augmentative communication systems.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-2000, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-2005   Who is a qualified provider of staff/family consultation and training?   To provide staff/family consultation and training, a provider must be one of the following licensed, registered or certified professionals and be contracted with DDD:

(1) Audiologist;

(2) Licensed practical nurse;

(3) Marriage and family therapist;

(4) Mental health counselor;

(5) Occupational therapist;

(6) Physical therapist;

(7) Registered nurse;

(8) Sex offender treatment provider;

(9) Speech/language pathologist;

(10) Social worker;

(11) Psychologist;

(12) Certified American sign language instructor;

(13) Nutritionist;

(14) Registered counselor; ((or))

(15) Certified dietician; or

(16) Recreation therapist certified by the National Council for Therapeutic Recreation.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-2005, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-2010   Are there limitations to the staff/family consultation and training I can receive?   (1) Expenses to the family or provider for room and board or attendance, including registration, at conferences are excluded as a service under staff/family consultation and training.

(2) Staff/family consultation and training require prior approval by the DDD regional administrator or designee.

(3) The dollar limitations for aggregate services in your Basic or Basic Plus waiver limit the amount of service you may receive.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-2010, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-2200   What are transportation services?   Transportation services provide reimbursement to a provider when the transportation is required and specified in the waiver plan of care or individual support plan. This service is available in all four HCBS waivers if the cost and responsibility for transportation is not already included in your provider's contract and payment.

(1) Transportation provides ((the person)) you access to waiver services, specified by ((the)) your plan of care or individual support plan.

(2) Whenever possible, ((the person)) you must use family, neighbors, friends, or community agencies that can provide this service without charge.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-2200, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-2210   Are there limitations to the transportation services I can receive?   The following limitations apply to transportation services:

(1) Transportation to/from medical or medically related appointments is a Medicaid transportation service and is to be considered and used first.

(2) Transportation is offered in addition to medical transportation but cannot replace Medicaid transportation services.

(3) Transportation is limited to travel to and from a waiver service.

(4) Transportation does not include the purchase of a bus pass.

(5) Reimbursement for provider mileage requires prior approval by DDD and is paid according to contract.

(6) This service does not cover the purchase or lease of vehicles.

(7) Reimbursement for provider travel time is not included in this service.

(8) Reimbursement to the provider is limited to transportation that occurs when you are with the provider.

(9) You are not eligible for transportation services if the cost and responsibility for transportation is already included in your ((waiver)) provider's contract and payment.

(10) The dollar limitations for aggregate services in your Basic or Basic Plus waiver limit the amount of service you may receive.

(11) Transportation services require prior approval by the DDD regional administrator or designee.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-2210, filed 12/13/05, effective 1/13/06.]

ASSESSMENT AND ((PLAN OF CARE)) INDIVIDUAL SUPPORT PLAN
AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-3000   What is the process for determining the services I need?   Your service needs are determined through the ((ICF-MR level of care)) DDD assessment and the service planning process as defined in chapter 388-828 WAC. Only identified health and welfare needs will be authorized for payment in the ISP.

(1) You receive an initial and annual assessment of your needs using a department-approved form.

(a) ((The ICF-MR level of care assessment identifies your need for waiver services)) You meet the eligibility requirements for ICF/MR level of care.

(b) The "comprehensive assessment reporting evaluation (CARE)" tool will determine your eligibility and amount of personal care services.

(c) If you are in the Basic ((or)), Basic Plus or CORE waiver, ((a)) the DDD ((respite)) assessment will determine the amount of respite care available to you.

(2) From the assessment, DDD develops your waiver plan of care (((POC))) or individual support plan (ISP) with you and/or your legal representative and others who are involved in your life such as your parent or guardian, advocate and service providers.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-3000, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-3055   What is a waiver ((plan of care (POC))) individual support plan (ISP)?   (1) The ((plan of care)) individual support plan (ISP) replaces the plan of care and is the primary tool DDD uses to determine and document your needs and to identify the services to meet those needs. Your plan of care remains in effect until a new ISP is developed.

(2) Your ((plan)) ISP must include:

(a) ((The services that you and DDD have agreed are necessary for you to receive in order to address your health and welfare needs as specified in WAC 388-845-3000)) Your identified health and welfare needs;

(b) Both paid and unpaid services ((you receive or need)) approved to meet your identified health and welfare needs as identified in WAC 388-828-8040 and 388-828-8060; and

(c) How often you will receive each waiver service; how long you will need it; and who will provide it((; and

(d) Your signature on)).

(3) For an initial ISP, you or your legal representative must sign or give verbal consent to the plan indicating your agreement to the receipt of services.

(((3))) (4) For a reassessment or review of your ISP, you or your legal representative must sign or give verbal consent to the plan indicating your agreement to the receipt of services.

(5) You may choose any qualified provider for the service, who meets all of the following:

(a) Is able to meet your needs within the scope of their contract, licensure and certification;

(b) Is reasonably available;

(c) Meets provider qualifications in chapters 388-845 and 388-825 WAC for contracting; and

(d) Agrees to provide the service at department rates.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-3055, filed 12/13/05, effective 1/13/06.]


NEW SECTION
WAC 388-845-3056   What if I need assistance to understand my plan of care or individual support plan?   If you are unable to understand your plan of care or individual support plan and the individual who has agreed to provide assistance to you as your necessary supplemental accommodation representative is unable to assist you with understanding your individual support plan, DDD will take the following steps:

(1) Consult with the office of the attorney general to determine if you require a legal representative or guardian to assist you with your plan of care or individual support plan.

(2) Continue your current waiver services.

(3) If the office of the attorney general or a court determines that you do not need a legal representative, DDD will continue to try to provide necessary supplemental accommodations in order to help you understand your plan of care or individual support plan.

[]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-3060   When is my plan of care or individual support plan effective?   ((Your)) (1) For an initial plan of care or individual support plan, the plan is effective the date DDD signs and approves it after a signature or verbal consent is obtained.

(2) For a reassessment or review of a plan of care or individual support plan, the plan is effective the date DDD signs and approves it after a signature or verbal consent is obtained.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-3060, filed 12/13/05, effective 1/13/06.]


NEW SECTION
WAC 388-845-3061   Can a change in my plan of care or individual support plan be effective before I sign it?   If you verbally request a change in service to occur immediately, DDD can sign the plan of care or individual support plan and approve it prior to receiving your signature.

(1) Your plan of care or individual support plan will be mailed to you for signature.

(2) You retain the same appeal rights as if you had signed the plan of care or individual support plan.

[]


NEW SECTION
WAC 388-845-3062   Who is required to sign or give verbal consent to the plan of care or individual support plan?   (1) If you do not have a legal representative, you must sign or give verbal consent to the plan of care or individual support plan.

(2) If you have a legal representative, your legal representative must sign or give verbal consent to the plan of care or individual support plan.

(3) If you need assistance to understand your plan of care or individual support plan, DDD will follow the steps outlined in WAC 388-845-3056 (1) and (3).

[]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-3065   How long is my plan effective?   (1) Your plan of care is effective ((through the last day of the twelfth month following the effective date)) until it is replaced by your individual support plan.

(2) Your individual support plan is effective through the last day of the twelfth month following the effective date or until another ISP is completed, whichever occurs sooner.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-3065, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-3070   What happens if I do not sign or verbally consent to my ((plan of care)) individual support plan (ISP)?   If DDD is unable to obtain the necessary signature ((on the plan of care from you or your legal representative)) or verbal consent for an initial, reassessment or review of your individual support plan (ISP), DDD will take one or more of the following actions:

(1) ((DDD will continue providing services as identified in your most current POC for up to thirty days from the date you were notified of the plan to implement your most current POC.

(2) After thirty days, unless you file an appeal, DDD will assume consent and implement the new POC without your signature or the signature of your legal representative)) If this individual support plan is an initial plan, DDD will be unable to provide waiver services. DDD will not assume consent for an initial plan and will follow the steps described in WAC 388-845-3056 (1) and (3).

(2) If this individual support plan is a reassessment or review and you are able to understand your ISP:

(a) DDD will continue providing services as identified in your most current plan of care or ISP until the end of the ten-day advance notice period as stated in WAC 388-825-105.

(b) At the end of the ten-day advance notice period, unless you file an appeal, DDD will assume consent and implement the new ISP without the required signature or verbal consent as defined in WAC 388-845-3062 above.

(3) If this individual support plan is a reassessment or review and you are not able to understand your ISP, DDD will continue your existing services and take the steps described in WAC 388-845-3056.

(4) You will be provided written notification and appeal rights to this action to implement the new ((POC)) ISP.

(((4))) (5) Your appeal rights are in WAC 388-845-4000 and WAC 388-825-120 through 388-825-165.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-3070, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-3075   What if my needs change?   You may request a review of your plan of care or individual support plan at any time by calling your case manager. If there is a significant change in your condition or circumstances, DDD must reassess your plan of care or individual support plan with you and amend the plan to reflect any significant changes. This reassessment does not affect the end date of your annual plan of care or individual support plan.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-3075, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-3095   Will I have to pay toward the cost of waiver services?   (1) ((Depending on your SSI status, Medicaid status, income and resources, you may be required to participate towards the cost of your care. DDD determines what amount, if any, you pay.

(2) If you live in a licensed facility, you participate from your earned and unearned income per rules in WAC 388-515-1510:

(a) If you have nonexempt income that exceeds the cost of your waiver services, you may keep the difference.

(b) If you are eligible for SSI, you pay only for room and board.

(c) If you are not eligible for SSI, you may be required to participate towards the cost of your waiver services in addition to your facility room and board rate)) You are required to pay toward board and room costs if you live in a licensed facility or in a companion home as room and board is not considered to be a waiver service.

(2) You will not be required to pay towards the cost of your waiver services if you receive SSI.

(3) You may be required to pay towards the cost of your waiver services if you do not receive SSI. DDD determines what amount, if any, you pay in accordance with WAC 388-515-1510.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-3095, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-4000   What are my appeal rights under the waiver?   ((You have)) In addition to your appeal rights under WAC 388-825-120, you have the right to appeal the following decisions:

(1) ((Any denial, reductions, or termination of a service.

(2) A denial or termination of your choice of a qualified provider.

(3) Your termination from waiver eligibility.

(4))) Disenrollment from a waiver under WAC 388-845-0060, including a disenrollment from a waiver and enrollment in a different waiver because DDD has determined that you do not have a need for all the services on the waiver in which you have been enrolled.

(2) A denial of your request to receive ICF/MR services instead of waiver services; or

(3) A denial of your request to be enrolled in a waiver, subject to the limitations described in WAC 388-845-4005.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-4000, filed 12/13/05, effective 1/13/06.]


AMENDATORY SECTION(Amending WSR 06-01-024, filed 12/13/05, effective 1/13/06)

WAC 388-845-4005   Can I appeal a denial of my request to be enrolled in a waiver?   ((You do not have an appeal right to a denial to be enrolled in a waiver)) (1) If you are not enrolled in a waiver and your request to be enrolled in a waiver is denied, your appeal rights are limited to the decision that you are not eligible to have your request documented in a statewide database because you do not need ICF/MR level of care per WAC 388-845-0070, 388-828-8040 and 388-828-8060.

(2) If you are enrolled in a waiver and your request to be enrolled in a different waiver is denied, your appeal rights are limited to DDD's decision that the services contained in a different waiver are not necessary to meet your health and welfare needs and that the services available on your current waiver can meet your health and welfare needs.

(3) If DDD determines that the services offered in a different waiver are necessary to meet your health and welfare needs, but there is not capacity on the different waiver, you do not have the right to appeal any denial of enrollment on a different waiver when DDD determines there is not capacity to enroll you on a different waiver.

[Statutory Authority: RCW 71A.12.030, 71A.12.12 [71A.12.120] and chapter 71A.12 RCW. 06-01-024, 388-845-4005, filed 12/13/05, effective 1/13/06.]


REPEALER

     The following sections of the Washington Administrative Code are repealed:
WAC 388-845-0025 Does this change in waivers affect the waiver services I am currently receiving?
WAC 388-845-0075 How is a child age twelve or younger assessed for ICF/MR level of care?
WAC 388-845-0080 What score indicates ICF/MR level of care if I am age twelve or younger?
WAC 388-845-0085 If I am age twelve or younger, what if my score on the current needs assessment does not indicate ICF/MR level of care?
WAC 388-845-0090 How is a person age thirteen or older assessed for ICF/MR level of care?
WAC 388-845-0095 What score indicates ICF/MR level of care if I am age thirteen or older?
WAC 388-845-0096 If I am age thirteen or older, what if my score on the current needs assessment does not indicate the need for ICF/MR level of care?
WAC 388-845-1606 Can DDD approve an exception to the requirements in WAC 388-845-1605?
WAC 388-845-3005 What is the waiver respite assessment?
WAC 388-845-3010 Who must have a waiver respite assessment?
WAC 388-845-3025 How often is this waiver respite assessment completed?
WAC 388-845-3030 What items are assessed to determine my respite allocation?
WAC 388-845-3035 How is the waiver respite assessment scored?
WAC 388-845-3040 When will the new respite assessment go into effect?
WAC 388-845-3045 How will I know the results of my respite assessment?
WAC 388-845-3050 What is the effective date of my respite allocation?

Washington State Code Reviser's Office